pdf of this article

For additional information, contact:

Sonia Rapaport, MD
(Family Medicine)
Cindy Fraed, MD

121 S. Estes Drive, Suite 205-D, Chapel Hill, NC 27514.

Telephone: (919) 969-1414.

Sonia Rapaport, MD, is President of the ISEAI board; she is certified by the American Board of Family Medicine, and the American Board of Integrative and Holistic Medicine

Concern About Mold in
Water-Damaged Space

By Sonia Rapaport, MD, MFA

Sonia Rapaport, MD, MFA

Hurricane Florence devastated significant portions of our state and while repair of the visible damage has begun, a hidden and unrecognized danger is just beginning to take effect. Mold and other microbes thrive in water-damaged buildings, but not all of this growth is visible. Whether you see mold growth or not, your health may be at risk from exposure to these microbes. The most important thing you can do to prevent this is to be aware of the risks, the signs of illness, and the basic steps of treatment.

The Risk

The growth of molds and other illness-causing microbes begins with moisture. These organisms are found everywhere, they are nourished by the building materials we use in homes and offices, and they love the warm temperatures of our indoor spaces. Yet despite these optimal conditions for their growth, it takes increased moisture for them to bloom. Different mold species have different moisture requirements. Aspergillus species, for instance, prefer damp air and grow in homes with higher humidity. Do you see condensation on the inside of your home? You may have Aspergillus growth. Stachybotrys (the classic “toxic black mold”) and Chaetomium prefer higher moisture content and tend to grow on saturated building materials. Have you had a leak? You may find Stachybotrys or Chaetomium growing.

The flooding and soaking of homes, the delays in clean up (which should be within 24-48 hours), the lack of power to drive air conditioning to cool and dry out the air, and overwhelming nature of the clean-up that can make efforts suboptimal, create the optimal conditions for mold growth. If you can’t see visible mold, it doesn’t mean you don’t have a mold problem. What does your home or work smell like? Musty? Moldy? Our noses are often better able to detect the microbial Volatile Organic Compounds (mVOCs) produced by molds than our eyes are able to see them.

The Signs of Illness

Some people feel ill even without obvious signs of mold growth. When we inhabit a water-damaged building, we breathe in the air found in that space. As molds and other microbes grow, they compete with one another and produce toxins and break off fragments that are released into the air. They extrude spores, which act like seeds to spread to new areas. All of these products become airborne, and can be inhaled by someone living or working in the space. It’s the inhalation of these microbial antigens that can cause illness.

When we breathe in fragments, spores, or toxins, our body recognizes the substances as foreign and turns on the immune system to fight against them. Unfortunately, scientific research suggests that these products can have a negative impact on the immune system. Some people are more susceptible to the inflammatory and immune suppressing effects of these inflammagens, because of underlying conditions such as pre-existing infections, autoimmune illnesses, mitochondrial dysfunction, and even hypermobility.

Early signs of reactivity, called environmentally acquired illness (EAI), include coughs, congestion, watery or itchy eyes, blurred vision, rash. As the inflammatory response increases, individuals can experience diarrhea and abdominal pain or cramping, hormonal imbalances (more PMS, difficulty with menopause, lower testosterone levels), dehydration with frequent urination, fatigue and insomnia. But the most significant symptoms tend to be brain based. Memory problems (especially problems finding the right word), “brain fog” problems learning new information, problems with focus and attention, headaches, pain and body aches, anxiety, and depression.

Individuals seek help from their doctors, undergo routine tests (generally normal) and are often referred to specialist after specialist until they are told that there is nothing wrong with them or that “it’s all in your head.” But rather than see a specialist, who generally focuses on a small area of the body, going to a clinician who is experienced in multi-system and multi-symptom illnesses can provide the answers for someone struggling with environmentally acquired illness (EAI). Clinicians may run lab tests that can confirm an inflammatory response, may look for mycotoxins in urine, or may review brain MRIs to assess changes that may result from exposure.

Basic Treatment Steps

Fortunately for many people exposed to water-damaged buildings, treatment can begin before seeking help from a medical provider. The first and most important step is to remove yourself from the exposure. This is often the most difficult and expensive part of treatment. Moving to a safe place can be impossible for some people, but absolutely necessary if you’re ill. Doing HERTSMI or ERMI testing on a new place will help determine if the new place is safe; if you have no choice or can’t afford the HERTSMI (approximately $125-$155), then be sure to look at vents, under sinks, and ceilings; if a building smells moldy, avoid it. If you can’t move, then spend your time in the part of the house that is the least affected. Remember that these aerosolized products are also falling onto and into your furniture and personal effects. Don’t move soft furniture such as sofas from a moldy environment to a new, clean environment. Hard furniture can be cleaned by using a leaf blower and then wiping down with a solution of 50 percent water and 50 percent alcohol. Clothes can be cleaned with detergent and Borax.

If you are able to remove yourself from the environment but find that you have to go back to your flooded home, take personal protective gear: gloves, face mask designed to filter out mold (N100 or P100 if you’re going to spend more than a few minutes in the space or if you’re already ill; N95 if you’re just going in to quickly assess the damage), and even a Tyvec suit if you’ll be working in the space.

Removing the inflammagens from your system with the use of a binder is the next step. While medications such as cholestyramine and Welchol, two potent binders, are available only through prescribing clinicians, people have been using other food-grade binders such as activated charcoal, bentonite clay, clinoptillite, chlorella, diatomaceous earth, and even okra. These over-the-counter products may not completely eliminate the inflammagens and restore health, but they are a good start for someone who has been exposed. Since binders will also bind to other nutrients, they are best taken at least 1 hour after a meal or 30 minutes before a meal, and even further away from medications such as hormones. As with all supplements, you should check with your health care provider to make sure that these are safe for you to take.

Beyond the Basics

Finally, if you have developed symptoms that you believe are related to environmental exposures and are not improving with removal from exposure and the use of binders, consider seeing a clinician trained in EAI. We’re fortunate to have several such clinicians in our state. Start by looking at, a professional medical society whose mission is to raise awareness and train clinicians in this growing field.